Provider Demographics
NPI:1720197791
Name:CENTER FOR ADVANCED PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-691-2272
Mailing Address - Street 1:1 E JACKSON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5816
Mailing Address - Country:US
Mailing Address - Phone:912-691-2272
Mailing Address - Fax:
Practice Address - Street 1:1 E JACKSON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5816
Practice Address - Country:US
Practice Address - Phone:912-691-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF63558Medicare UPIN